Out of Pocket Calculator Help

Non Participating Coinsurance Maximum Allowable Per Day

The Non Participating Coinsurance Maximum Allowable Per Day can be entered in the Non Participating Hospital portion of the Coinsurance section in the Copay/Coinsurance Sheet. This provision is included in a number of PPO plans, and sets a dollar limit on how much the plan will cover per day for allowable non participating hospital charges. For example, if the Non Participating Coinsurance Maximum Allowable Per Day is $2,500, but a non participating hospital had actual charges of $3,000 for that day, the excess $500 would all be an out of pocket expense, and any coinsurance would be calculated off the maximum allowable amount ($2,500.)

You should only make an entry if the health plan model you are using in your scenario has this feature, and you don’t want to use the default value provided in your model (meaning you want to customize your entry based on a specific health plan you are using in your scenario).